The 50 most-cited articles in Nursing Standard, 2023

Heart failure (HF) is associated with high morbidity and mortality and is a significant public health concern. Globally, the prevalence of HF is increasing and prognosis remains suboptimal for people with the condition. HF has significant effects on patients, their families and healthcare services. People with HF can present with acute or chronic signs and symptoms. This article provides an overview of HF including its prevalence, pathophysiology, causes, diagnosis and management. It details the pharmacological treatments that may be used and the nurse's role in caring for patients with the condition.

Person-centred care involves nurses working in partnership with patients to ensure their needs and preferences are at the centre of their healthcare, as well as considering the biographical and social factors that are relevant to the person's health. This aims to support patients in developing the knowledge, confidence and skills to make informed decisions about treatment and to manage their own care where possible. This article discusses the concept of person-centred care and considers some of the facilitators and barriers that may affect its implementation in healthcare practice. It also explores some of the approaches that nurses can use to support person-centred care, such as cultural humility and role modelling.

The ability to reflect on, and learn from, practice experiences is essential for nurses when seeking to provide effective person-centred care. This article outlines the various types of reflection that nurses can use, such as reflection-in-action and reflection-on-action. It also details some of the main models of reflection and explains how nurses might develop their skills in reflection to enhance the quality of patient care. The article provides examples of cases and reflective activities to demonstrate how nurses can use reflection in their practice.

The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.

Nurses in all settings have an important role in preventing non-communicable diseases such as cardiovascular disease, cancer, respiratory disease and diabetes mellitus. They have multiple daily opportunities in their practice to discuss health with people, with the aim of supporting behaviour changes that reduce the risk of non-communicable diseases and the associated health-related and economic challenges. Incorporating the principles of healthy conversations into all daily interactions provides opportunities for nurses collectively to promote health on an individual basis to millions of people. However, many nurses have not received training in such behaviour change interventions. This article explains the principles and potential benefits of healthy conversations, and emphasises the importance of training to promote nurses' knowledge, skills, confidence and motivation to engage in such conversations.

Administering medicines by intramuscular (IM) injection is a familiar, though not necessarily common, nursing procedure. To ensure effective administration of IM injections it is important that nurses are up to date with the evidence on factors such as selection of injection site, use of appropriate equipment and injection technique. This article explores the evidence on effective administration of IM injections with the aim of enhancing nurses' decision-making and technique when undertaking this procedure.

Providing person-centred care that takes into account each patient's individual needs and priorities is crucial at the end of life. Nurses need to be aware of the main aspects of person-centred care, such as supporting shared decision-making, developing therapeutic nurse-patient relationships, and considering the patient's physical, psychological, social and spiritual needs. This article discusses the concept of person-centred care in the context of providing end of life care to patients and their families. It explains the benefits and barriers to providing person-centred end of life care, and outlines some of the areas that nurses and other healthcare professionals need to consider to promote effective care.

Emotional intelligence (EI) is considered essential to nursing practice, but it is unclear how best to support nursing students to develop EI skills. This article details a literature review that was undertaken to explore EI in preregistration nurse education and to identify effective methods for developing nursing students' EI skills. A total of 12 articles were included in the review, from which data were extracted, compared and categorised. Three main areas were identified regarding EI in preregistration nurse education: EI constructs, EI components and EI teaching methods. The review found that a range of EI constructs and components may be included in nurse education curricula, meaning that there is often inconsistency in the approaches used. Classroom teaching methods were primarily used, alongside online methods and experiential methods such as simulation-based learning. The findings of the review suggest there is a need for greater consistency in the EI constructs and components used in preregistration nurse education, as well as further research to determine which EI…

Climate change is one of the most significant global challenges and is already having detrimental effects on people's health. Pollution levels and ambient temperatures continue to increase, resulting in higher levels of humidity and pollen production. These environmental threats can affect many vulnerable patients, particularly those with respiratory and cardiovascular conditions, and nurses have a crucial role in raising awareness of the health implications of climate change. This article explores the pathophysiological effects of climate change on patients with asthma, chronic obstructive pulmonary disease and cardiovascular disease, and aims to enhance nurses' understanding of the health challenges of climate change.

Skin tears are acute wounds caused by mechanical forces resulting in the separation of the skin's outer layers. Skin tears are more likely to occur in vulnerable people such as older people and people with neurodegenerative conditions. Rising life expectancy means that the number of patients with skin tears is expected to increase. This article describes the characteristics of skin tears, details the risk factors for skin tears and explains the importance of using a holistic, evidence-based and person-centred approach to skin tear prevention, assessment and treatment. The article outlines the crucial role of nurses as part of the multidisciplinary team in the management of skin tears.

Patient experience is a crucial measure of the quality of patient care in healthcare settings. It encompasses all the patient's interactions with staff and their exposure to equipment, procedures, environment and service structure during one care episode. Capturing patient experience is one way of ensuring that patients' voices are heard and can form the basis of an audit or service improvement project designed to evaluate or enhance the patient-centredness of care. Nurses are increasingly involved in audits and service improvement projects, so it is important that they understand what patient experience is, how it differs from patient satisfaction and what approaches can be used to measure it. This article defines patient experience, describes data collection methods and discusses factors to consider when planning to collect patient experience data, notably the validity, reliability and rigour of the data collection tool.

Nurses are well placed to deliver brief opportunistic health promotion interventions during routine encounters with patients. Brief interventions have been shown to be effective in prompting behaviour change among people who engage in harmful drinking or substance misuse. Nurses can use their communication, relationship-building and partnership-working skills to support people to consider behaviour change. This article explains the concepts that underlie brief behaviour change interventions, which include motivational interviewing and the transtheoretical model of behaviour change. The article also describes practical tools and techniques that nurses can use to deliver such interventions.

Dietary strategies for the management of patients with type 2 diabetes can be effective in maintaining glycaemic control. In some cases, the use of specific and supervised dietary strategies can result in remission of the condition. Despite this, the use of anti-diabetes medicines remains the prevailing focus of treatment guidelines. Nurses in primary care are involved in all aspects of management of patients with type 2 diabetes, including advising on lifestyle changes such as diet. This article considers some of the barriers and enablers to dietary management of patients with type 2 diabetes and offers practical advice that nurses can share with their patients. The author also discusses remission of type 2 diabetes and the dietary approaches used to achieve this.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, and its prevalence increases significantly with age. It is linked to serious adverse outcomes, including stroke and other thromboembolic events, heart failure and other serious conditions. AF is categorised according to its persistence and duration and its management includes rhythm and rate control to address symptoms and reduce the risk of complications. As a common and potentially serious condition with high morbidity, AF is associated with significant burden on patients, healthcare services and public health, and it is essential for nurses to understand the condition. This article provides an overview of AF, including its diagnosis, symptoms, risk factors and management.

Skin tears, defined as traumatic wounds caused by mechanical forces, can be debilitating for individuals, causing pain and reduced mobility. Although skin tears can develop throughout the lifespan, older age can make the skin increasingly susceptible to this type of injury. Studies have found wide variation in the incidence and prevalence of skin tears, in part because of suboptimal recognition and reporting practices among healthcare professionals. Effective prevention of skin tears requires a standardised approach to risk assessment, prevention, recognition and classification, such as that offered by the International Skin Tear Advisory Panel (ISTAP) best practice recommendations. This article examines the literature on the incidence, prevalence, prevention and recognition of skin tears, and outlines some of the ISTAP best practice recommendations on risk assessment, prevention and recognition. The authors also consider the need for patient and healthcare professional education to optimise the prevention of skin tears.

Neuropathic pain results from damage to the nerves. It affects many in the general population, but its prevalence is higher in certain groups, for example those who have undergone certain procedures or systemic anti-cancer therapy and people with conditions such as diabetes mellitus, viral infections or central nervous system disorders. Regardless of the cause, neuropathic pain can have significant adverse effects on people's quality of life, so nurses need to be able to conduct a holistic pain assessment that incorporates physical, emotional, social and spiritual aspects. This article explores the prevalence, characteristics and nursing assessment of neuropathic pain with the aim of improving nurses' awareness, practice and care of people affected by this type of pain.

Elevated blood glucose levels (hyperglycaemia) and insulin resistance over time are determinants of the onset and progression of a range of complications associated with diabetes mellitus, including cardiovascular disease, neuropathy (nerve damage), diabetic kidney disease and eye conditions. Maintaining optimal glycaemic control may reduce the risk of developing such complications and has been shown to reduce the severity of some renal and eye conditions. However, achieving optimal glycaemic control can be challenging because of various physical and psychological factors that can cause fluctuations in blood glucose levels. This article provides an overview of some of the complications associated with type 1 and type 2 diabetes.

Skilled and compassionate communication with patients and their families is a priority in all areas of clinical practice. This is particularly important in palliative and end of life care, where people may feel frightened and vulnerable and require clear, honest and compassionate communication from healthcare professionals. However, many patients and families have reported dissatisfaction with their interactions with healthcare professionals in end of life care, including a lack of compassion and understanding of their emotional well-being. This article explores the literature on end of life communication with patients and families and discusses how improvements can be made in this area of practice.

Nurses working in any setting may be required to assist the courts or coroners by preparing statements or giving evidence in court. Nurses can act as 'professional witnesses' who provide evidence of something they have seen, heard or been involved with as part of their professional duties. This article outlines how nurses should respond to requests for written statements and suggests a format for providing such statements. It also explains the typical approach to providing oral evidence in court and how nurses should prepare and present themselves in the witness box.

The Greener Nursing Practice award winner shares her tips for reducing PPE use with support from staff

Nurses experience a range of challenges in their practice that can adversely affect their well-being, for example work-related stress and workforce issues. These challenges may have been intensified by various factors, such as the coronavirus disease 2019 (COVID-19) pandemic and shift working. This article considers the concept of well-being and explores nurses' well-being in the context of ongoing stressors and workforce issues. It also examines some of the effects of shift work on nurses' well-being and how these could be mitigated. The authors outline a range of self-care practices that nurses could engage in and consider how they may be supported in this by their line managers and healthcare organisations.

The death of a patient or service user can be difficult to deal with. Nurses in diverse roles and settings talk about their experiences and their strategies for coping

As part of a project to review the delivery of healthcare services in Torbay and South Devon, England, the author undertook a literature review focusing on the specialty of men's health. Men have a shorter life expectancy than women and this discrepancy is particularly pronounced in areas of social deprivation such as those found in the coastal and rural communities of the author's locality. The concept of men's health is complex, and this literature review identified five main themes that can have a significant influence on the delivery of healthcare services for men: masculinity, ethnicity, mental health, relevance of place, and access to services. In this article, the author discusses these themes and considers approaches that could be used to improve the provision of men's healthcare.

There is little evidence to suggest that people with dementia experience less pain than those without dementia, however they are less likely to report their pain due to the cognitive impairments they experience as their dementia progresses. A comprehensive pain assessment that involves family members, carers and/or friends in the process is crucial to gain an understanding of a person's medical and pain history, and to ensure effective pain management in people with dementia. This article describes the identification, assessment and management of pain in older people with dementia. The author includes a fictional case study with the aim of supporting nurses to reflect on possible indicators of pain in a person with dementia and to consider the tools they may use when identifying and assessing this pain.

Professional nurse advocates give clinical and well-being support to colleagues, in a role underpinned by new education standards

The nursing associate role was introduced as a 'bridge' between healthcare assistants and nurses to support patient care. However, the role has involved many challenges in terms of its implementation in established nursing teams. This article details a service evaluation that explored the experiences of the nursing associate role among clinical staff in one community NHS trust using an online questionnaire and in-depth interviews. Three themes were identified from the data: nursing associate training and support; the nursing associate role in development; and nursing associate role recognition and prospects. Overall, the findings showed that trainee nursing associates enjoyed the academic aspects of their training, but support was variable. Additionally, the nursing associate role was viewed as being 'in development' and, while wider recognition of nursing associates is required, the nursing associate role offers a unique career opportunity.

Effective nursing care is built on the purposeful connection between nurse and patient and is enabled by open communication, trust and healthy boundaries

Physical and mental ill health often go hand in hand, which is why nurses qualified in both areas are well placed for offer 360° care

Anxiety disorders are the most prevalent mental health issues worldwide and can have significant detrimental effects on people's quality of life and daily functioning. Nurses in a range of healthcare settings are likely to encounter people with various anxiety disorders, so it is essential that they have adequate knowledge and understanding of these conditions. This article explores the development of anxiety, before outlining the aetiologies and symptoms of common anxiety disorders. The author also provides an overview of some of the treatments available for anxiety disorders and explains the nurse's role in supporting those affected by these conditions.

BACKGROUND: Preregistration nursing students frequently seek employment as healthcare support workers (HCSWs). However, little is known about their experience of alternating between these two roles. AIM: To explore the experiences of preregistration nursing students working as healthcare support workers. METHOD: Semi-structured interviews were conducted with three preregistration nursing students working part-time as HCSWs in the NHS. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. FINDINGS: Analysis of the interview data produced the overarching theme of 'walking the tightrope'. The overarching theme contained four subthemes: 'preparing to get on the tightrope'; 'balancing on the tightrope'; 'having the stamina to stay on the tightrope'; and 'preparing to get off the tightrope'. CONCLUSION: Nursing students gained experience and confidence while working as HCSWs, but were challenged by the limitations and demands of the role.

With students facing financial pressure and struggling to secure placements, how well are we preparing our future nurses – and what more can be done?

Complex regional pain syndrome is a rare and not well understood chronic pain condition that can affect anyone, irrespective of age and sex. It is important that nurses and the wider healthcare team are aware of the symptoms and recommended management of this condition, with timely diagnosis and appropriate rehabilitation being particularly important. This article provides an overview of complex regional pain syndrome and explains what is involved in the diagnosis and treatment of this condition. Understanding the complexity of the condition and the relevant management guidelines will enable nurses to provide effective care and support for patients.

It can help maintain a healthy, supported nursing workforce, yet access to good quality clinical supervision is patchy

People with dementia commonly experience pain, but it is often unrecognised, unrelieved and remains an underlying issue as the condition progresses. As a result, pain management for people with dementia is inadequate. Community nurses have a fundamental role in the assessment and management of pain and in supporting family carers. This article details the causes and effects of pain in people with dementia, explains the components of a holistic approach to individualised pain assessment, and describes various pharmacological and non-pharmacological interventions that can be used to manage pain in this population.

Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.

Rapid sociocultural shifts in understanding and acceptance of variations in sexual orientation and gender identity have occurred in recent decades, and UK health and social care providers have a legal obligation to address inclusion, discrimination and equality in policies and services. Despite this, lesbian, gay, bisexual and transgender + (LGBT+) people continue to report inadequate health outcomes and suboptimal experiences of care. This article considers the health ecology in relation to those who identify as LGBT+ and outlines the concept of intersectionality. The author discusses some of the issues experienced by LGBT+ people in relation to various physical and mental health conditions and services. The article aims to encourage nurses to consider what steps they can take to improve care for this group.

Anorexia nervosa is a challenging and highly distressing illness associated with significant and often debilitating symptoms that affect the person's physical and mental well-being, as well as their wider social networks. Although some patients can make important steps in their recovery in the community, many will become significantly unwell and require medical stabilisation and refeeding in an acute medical ward as a result of significant weight loss. This article describes some of the challenges experienced by adult nurses when caring for patients with anorexia nervosa on acute medical wards and explores how the patient's distress may manifest and complicate the recovery process. The article also discusses the principles of psychologically informed care and therapeutic interactions that nurses can use to promote recovery and ensure optimal practice.

Find out how small adjustments to your body language can help improve the therapeutic relationship

A new course on nurse advocacy, activism and resistance prepares nurses to be champions of patients, colleagues and the profession

Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or vomiting. The symptoms of migraine can have a significant adverse effect on a person's ability to undertake normal activities. Nurses have an important role in assisting patients in identifying migraine triggers and in supporting them to manage the symptoms of migraines through lifestyle changes and pharmacological treatments. This article describes different types of migraines and some differential diagnoses and 'red flag' symptoms that could indicate a more serious condition. The author also discusses non-pharmacological and pharmacological management strategies and treatments.

Creating a ‘public narrative’ helps you frame job applications in a new and compelling way and amplifies your professional voice. Here’s how telling (true) tales can work to your advantage

Kidney disease is a common occurrence and alters how the body processes many drugs. Therefore, prescribers must consider the person's renal function before prescribing medicines and may need to amend the dose of renally excreted drugs. At present, there is limited data regarding dose adjustment in renal impairment, so prescribers require knowledge of pharmacokinetics. Prescribers also need to understand how the kidneys process drugs when functioning normally to be able to predict how renal impairment may affect pharmacokinetics. This article offers practical guidance on prescribing for adults who have stable chronic kidney disease and do not meet the criteria for specialist assessment. It also explores important steps that prescribers can take to optimise medicines use in this population.

Despite recent technological advances in the field of surgery, neurological complications remain a significant post-operative issue. Two of the most common post-operative complications are delirium and post-operative cognitive decline, which occur frequently after cardiac surgery. This article provides an overview of delirium and post-operative cognitive decline, including risk factors, signs and symptoms, and diagnosis. The author also considers the nurse's role in managing patients who are at risk of, or have experienced, delirium or post-operative cognitive decline after cardiac surgery.

Healthcare organisations implement a range of staff well-being initiatives and increasingly focus on compassionate leadership. While formal interventions aimed at maintaining and enhancing staff well-being can be beneficial, they have practical limitations, such as staff turnover and challenges in meeting demand. Therefore, everyday conversations between nurses in leadership positions and their team members also have an important role in supporting staff well-being. One psychological model that nurse leaders may wish to use is acceptance and commitment therapy (ACT), which involves techniques such as mindfulness, acceptance and values clarification. This article outlines the principles of ACT and explains how leaders can use these to guide well-being conversations with staff.

Reducing the number of deaths by suicide is an important area in public health. Several factors, including excessive workload demands and burnout, mean that healthcare staff such as nurses are at higher risk of death by suicide compared with people working in other occupations. This article explores the contributory factors involved in suicide among healthcare professionals and outlines some of the methods that nurses can use to enquire about suicide risk with their colleagues. It also details appropriate interventions that nurses can use to reduce the risk of suicide among their colleagues. The authors aim to increase nurses' understanding of their role in suicide prevention in the healthcare workforce.

Surgical site infections (SSIs) are commonly reported healthcare-acquired infections that can have a detrimental effect on patient outcomes and quality of life. SSIs are associated with longer periods of hospitalisation and increased patient morbidity and mortality. A rigorous approach is required to identify and manage the risk of infection across the preoperative, intraoperative and post-operative phases of care. This article describes the causes of, risk factors for development and signs and symptoms of SSIs. The author emphasises the importance of a collaborative, holistic and multidisciplinary approach to the prevention and management of SSIs, which involves the nurse and other healthcare professionals working in partnership with the patient.

With nursing student attrition remaining high in 2022, we look at the pressures that force future nurses to leave before qualifying and how they could be tackled

Vitamin D deficiency is prevalent among various groups in the UK, and can result from insufficient sunlight exposure and dietary intake. There is a population-wide recommendation of 10 micrograms (400 international units) of vitamin D per day, with a daily supplement advised. However, supplement use is often suboptimal, compounding the risk of deficiency. Long-term vitamin D deficiency can cause rickets in children and osteomalacia or osteoporosis in adults. Therefore, it is important that nurses recognise which groups are at increased risk of vitamin D deficiency and understand how to assess people's vitamin D status. Nurses also need to be able to support the prevention and treatment of low vitamin D levels, which typically involves supplementation and lifestyle changes.

Acute kidney injury is a sudden reduction in renal function which impairs the kidneys' ability to maintain fluid, electrolyte and acid-base balance. The syndrome often develops secondary to severe illness and is associated with a significant increase in morbidity and mortality rate in critically ill patients. This article gives an overview of the pathophysiology and aetiology of acute kidney injury, as well as the associated complications and clinical diagnostic signs. The authors also describe some common causes of the syndrome in critically ill patients, specifically sepsis, liver failure and cardiac failure, and discuss patient management in the critical care setting, with a focus on haemodynamic support and continuous renal replacement therapy.

Safety in this area is key to becoming a competent nurse. Experts offer tips for students on gaining confidence and avoiding mistakes